An accident date is required for Federal program when an accident related diagnosis is present.
What this means: Some claims to this payer may reject for 'An accident date is required for Federal program when an accident related diagnosis is present.'
Provider action: Check the codes on the claims, are they considered accident codes? If so you will need to submit an accident indicator and and accident date on your claim.
Rejection Removal: Rejections will not be removed by Gateway EDI as they are valid.
Re-filing: Once this is corrected, you would want to re-file any claims that rejected for this reason.
An invalid code value was encountered. Element PAT01 (Individual Relationship Code) does not contain
What this means: Claims to this payer may reject for 'An invalid code value was encountered. Element PAT01 (Individual Relationship Code) does not contain a [OTER].'
Provider action: Verify that you are not sending the same insured and patient name on the claims, if so correct and resubmit.
Rejection Removal: Rejections will not be removed by Gateway EDI as they are valid.
Re-filing: Once this is corrected, you would want to re-file any
RENDERING PHYSICIAN IS REQUIRED
What this means: There are two possible reasons for this
rejection:
1. If the provider sends the claim with only the individual NPI in the billing loop and they are credentialed with a group NPI, then the claims will be rejected by the payer.
2. If the provider sends the claim with only the individual NPI in the billing loop and the entity type qualifier is 2 (non-person), then the claims will be rejected by the payer.
Resubmit with Group NPI (Box 33) information.
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